6 Education and information policies
144. In addition to interventions by clinicians to
discourage drinking, the Government's Strategy, as we have seen,
stresses "the importance of informing and supporting people
to make healthier and more responsible choices" through campaigns
and the provision of information. The Government told us that
this included:[182]
- public health education campaigns
to improve understanding of alcohol units and health risks; and
to challenge binge drinking and spread awareness of the consequences;
the DH drink prevention programme has an overall budget of £10
million in 2008-09 and consists of a 'units campaign' and a 'binge
drinking campaign'.
- planned campaigns from 2009 aimed at children
and their parents; the Department for Children, Schools and Families
(DCSF) told us that it was planning a new social marketing campaign
from 2009, aimed at young people and their parents, with £12.5
million funding over the next 3 years.
- The Chief Medical Officer's Guidance on the Consumption
of Alcohol by Children and Young People, which will support the
DCSF's campaign
- Labelling: the Government told us that it had
come to an agreement with the industry to introduce unit and health
information; on labels, it was hoped that the majority of labels
by market share would have complied by the end of 2008.
- Targeted support aimed at those who drink more
than double the Government's guidelines, including web-based support
and advice and an improved national helpline and an 'innovative
pilot' in the north west to target information to 'neighbourhoods,
individuals and their families'.
145. Government spending in 2009/10 on alcohol information
and education campaigns is £17.6m. Individual Department's
expenditure is as follows:[183]
- DH: £6.85m
- Home Office: £2m
- DCSF: £5m
- DfT: £3.75m
146. In addition, the alcohol industry funds activities
to promote sensible drinking. The Portman Group was set up in
1989 by the UK's leading alcohol producers; current members account
for the majority of the UK alcohol market. The Group's main role
currently is to encourage the industry 'to promote its products
responsibly, mainly through the operation of the Code of Practice
on the Naming, Packaging and Promotion of Alcoholic Drinks'.[184]
147. The Government set up the Drinkaware Trust,
in 2006. Its trustees include health professionals, representatives
of the drink and retail industry and others. It is funded producers
and retailers. In 2006 it took on the Portman Group's remit for
consumer education. During the inquiry the Trust announced a social
marketing campaign, spending up to £5m per year for five
years, to help tackle binge drinking.
148. Many witnesses were critical of the Government's
and industry bodies' information and education measures. The BMA
stated that the disproportionate focus upon, and funding of, public
information and educational programmes must be redressed.[185]
Specific criticisms were:
- the programmes have been shown
to have little impact on changing behaviour. Professor David Foxcroft,
a chartered psychologist specialising in the science of prevention,
told us that
a number of different studies had shown that traditional
types of alcohol education in schools, just telling people about
the risks associated with alcohol...are ineffective. I believe
that this is the message put across by the WHO report.[186]
Dr Peter Anderson added:
There is very good scientific evidence that information
campaigns and education campaigns on their own do not change behaviour.
These campaigns have to be done in association with policy changes
or done to help support policy changes. Just providing information
is not going to change people's behaviour.[187]
- The sums spent by Government
and the Drinkaware Trust are, as Professor Ian Gilmore, President
of the Royal College of Physicians, highlighted, insignificant
compared with the massive amounts of money spent by the industry;
Dr Anderson suggested that public education programmes could only
compete if advertising by the drinks industry was reduced to level
the playing field.[188]
- campaigns funded by the alcohol industry can
backfire, reinforcing heavy drinking due to creating a more favourable
impression of the industry;[189]
we were told:
The limited available research has shown that industry
funded educational programmes tend to lead to more positive views
about alcohol and the alcohol industry.
- the campaigns are not very
good; Sainsbury thought that there was considerable room for improvement,
as we discuss below.
149. Finally, there is concern that education and
information campaigns are emphasised and promoted by the industry
because it knows they do not work. The British Society of Gastroenterology
and the British Association for the Study of the Liver informed
us:
According to the DH, 25% of the UK population are
hazardous or harmful drinkers, but this minority consumes 75%
of alcohol sales. This phenomenon is well described in other countries
and means that the alcohol production and retail industries rely
on hazardous and harmful drinkers to supply three-quarters of
their profitability. One therefore has to question the motivation
of the alcohol industry to reduce alcohol related harm, and their
central role in policy making so far.[190]
150. Nevertheless, while the education and information
campaigns were much criticised, the critics did not believe that
they should be dropped altogether; rather it was thought that
while not effective on their own, they could be a useful part
of a wider strategy of which they were an element. Dr Anderson
told us:
Providing information and education is important
to raise awareness and impart knowledge, but, particularly in
a living environment in which many competing messages are received
in the form of marketing and social norms supporting drinking,
and in which alcohol is readily accessible, do not lead to changes
in behaviour. Reviews of hundreds of studies of school-based education
have concluded that classroom-based education is not effective
in reducing alcohol-related harm. Although there is evidence of
positive effects on increased knowledge about alcohol and on improved
alcohol related attitudes, there is no evidence for a sustained
effect on behaviour.[191]
The provision of good information does not change
behaviour, but can justify and lead people to respond better to
more powerful interventions such as raising prices. Dr Anderson
added:
warning labels are important in helping to establish
a social understanding that alcohol is a special and hazardous
commodity.[192]
151. Moreover, it is argued that people have a right
to information about a dangerous substance such as alcohol.
152. Other witnesses made suggestions for improving
both the campaigns and the information put on labels, arguing
for more focus on:
- the number of units contained
in alcohol containers; the RCP described a significant lack of
knowledge amongst the general public about guidelines relating
to alcohol:
Many people underestimate the amount of units they
are drinking. A YouGov survey of 1,429 drinkers in England found
more than a third did not know their recommended daily limit—2-3
units for women and 3-4 for men.[193]
Similarly, it is not widely known that there are
about 9 units in a bottle of 13% wine, which means that a woman
drinking half a bottle of wine a day is consuming over 30 units
a week, which is more than twice the recommended levels.
- The need to have a couple of
days each week alcohol-free.
- The health risks, perhaps including labels such
as 'Alcohol causes cancer, liver disease and other illnesses'.
153. Unfortunately, progress in labelling is proceeding
painfully slowly. In May 2007, the Department reached a United
Kingdom-wide voluntary agreement with the alcohol industry to
include specified unit and health information on alcohol labels.
The Government made clear their expectation that the majority
of labels should be covered by the end of 2008. In November 2009
the Government expected to be able to publish shortly the results
of independent monitoring from samples taken in April 2009. The
Government was about to look at whether a majority of labels were
covered by the expected information and whether the content was
consistent with the 2007 voluntary agreement. The Government stated
that
If we find that most labels are still not complying
with the voluntary agreement, we will consider what action we
can take to improve compliance, including using existing powers
under the Food Safety Act to make this a mandatory requirement.
We believe that consumers have a right to consistent, agreed information
on at least the large majority of alcohol labels, to enable them
to assess their intake of alcohol and to relate this to the Government's
guidelines.[194]
Conclusions and recommendations
154. Better
education and information are the main planks of the Government's
alcohol strategy. Unfortunately, the evidence is that they are
not very effective. Moreover, the low level of Government spending
on alcohol information and education campaigns, which amounts
to £17.6m in 2009/10 makes it even more unlikely they will
have much effect. In contrast, the drinks industry is estimated
to spend £600-800m per annum on promoting alcohol.
155. However,
information and education policies do have a role as part of a
comprehensive strategy to reduce alcohol consumption. They do
not change behaviour immediately, but can justify and make people
more responsive to more effective policies such as raising prices.
Moreover, people have a right to know the risks they are running.
We recommend that information and education policies be improved
by giving more emphasis to the number of units in drinks and the
desirability of having a couple of days per week without alcohol.
We also recommend that all containers of alcoholic drinks should
have labels, which should warn about the health risks, indicate
the number of units in the drink, and the recommended weekly limits,
including the desirability of having two days drink-free each
week. We doubt whether a voluntary agreement would be adequate.
The Government should introduce a mandatory labelling scheme.
182 The information below is taken from AL 01 Back
183
Source: Department of Health Back
184
Ev 123 Back
185
Ev 22 Back
186
Q 614 Back
187
Q 29 Back
188
Q 34 Back
189
Q 29 Back
190
Ev 68 Back
191
AL 58 Back
192
Ibid. Back
193
Ev 159 Back
194
HC Deb, 9 November 2009, c107W Back
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